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Research Project

Project STYLE (“Strength Through Youth Livin’ Empowered”)

Young Black men who have sex with men (MSM) have high rates of HIV infection and are less likely to receive HIV treatment than men of other racial groups. Men who have sex with men (MSM) represented 82% of all new HIV infections in 2015, and 92% among males ages 13-24.  New infections increased 26% among young MSM between 2008 and 2011, largely driven by an increase from 3,762 diagnoses in 2008 to 4,619 diagnoses among in 2011 among young Black MSM.  Fortunately, by 2014, rates of new HIV diagnoses among Black MSM stabilized, increasing less than 1%, and HIV diagnoses among young Black MSM men declined 2%. However, young Black MSM are still seven times more likely to be unaware of their HIV infection, compared to young MSM of other ethnic or racial groups. Researchers have identified multiple reasons that affect linkage to and engagement in healthcare among people living with HIV. Barriers to care occur at different social levels and include: individual (e.g., stigma), interpersonal (e.g., medical mistrust), social/ community level (e.g., lack of social support), and structural (e.g., lack of insurance or transportation to physician) issues.

The University of California, San Francisco PRC is collaborating with a local CBO that is implementing an adaptation of “Strength Through Youth Livin’ Empowered” (STYLE), which has shown to be effective in improving engagement in HIV healthcare among young Black and Latino MSM living with HIV. The local STYLE adaptation is called “M+” and addresses HIV-related health disparities among African Americans. STYLE seeks to diagnose, engage, and retain black MSM, prioritizing young MSM, living with HIV in primary healthcare services in Alameda County, California and adjacent counties.

Project Identifier “Strength Through Youth Livin’ Empowered” (STYLE)

Funding Source PRC Program

Project Status Active

Host Institution University of California, San Francisco

Health Topics HIV/AIDS & STD prevention | Sexual health

Research setting: Oakland, CA

Race or ethnicity African American or Black

Gender Males

Age group Adolescents (12-17 years) | Young adults (18-24 years) |Adults (25+)

Contact Information Center UCSF Prevention Research Center 3333 California Street, Suite 1300 San Francisco, CA 94143

Principal Investigator and PRC Director Marguerita Lightfoot Phone: 415-502-1000 ext. 17160 (vm only)

Research Project

SIP14-013 Understanding barriers to colorectal cancer screening in South Asians

Project Director/Lead Investigator: Ma Somsouk (UCSF PI); Susan L. Ivey (UCB Project Director/Co-PI); Scarlett Lin Gomez (CPIC Project Director/Co-PI); Marguerita Lightfoot, PhD (UCSF PRC PI) Specific Aim 1: We will conduct a community-based participatory research (CBPR) study to better understand specific patient attitudes and knowledge about cancer; knowledge about colorectal cancer prevention and detection; acceptability of different modalities of colorectal screening (stool-based testing versus endoscopic testing); barriers and facilitators to screening; access and use of health services; and health information seeking behavior. Building upon existing community-academic partnerships, we will:
  • Sub-Aim 1: Convene a CAB of patients, family members, and providers from local South Asian communities to provide input and guidance during all phases of the study. All focus group and interview domains and questions will be reviewed by community advisors prior to use.
  • Sub-Aim 2: Conduct 8 focus groups (FGs) among South Asian men and women (e.g., Asian Indian, Pakistani, and Bangladeshi groups in the San Francisco Bay area) to understand patient perceptions of cancer, cancer risks, and colorectal screening modalities.
  • Sub-Aim 3: Conduct a series of 10 interviews with local community providers and cancer experts to understand contextual and system-level factors in cancer prevention strategies and how they may affect low adherence to CRC screening in South Asian men and women, and to assess relevant interventions, strategies, and messages for improving uptake of colorectal cancer screening among South Asian men and women.
Specific Aim 2: We will apply novel classification techniques to analysis of existing population based data to identify subgroups of South Asians at highest risk of low adherence to CRC screening and late stage diagnosis, for informing targeted community interventions, communication strategies, and messaging to reach South Asian populations. We will:
  • Sub-Aim 1: Incorporate guidance from the CAB on key factors to consider in CRC screening. CAB input will inform the design of the analysis of existing population-based data and the interpretation of the results.
  • Sub-Aim 2: Use population-based California Cancer Registry data from 1988-2012 to assess prevalence of advanced CRC among South Asian ethnic groups and apply recursive partitioning to identify high-risk populations with high proportions of advanced disease.
  • Sub-Aim 3: Use contemporary state-level data (California Health Interview Survey data 2001–2009) to assess trends in CRC screening among South Asians and identify highrisk populations with low adherence to CRC screening guidelines, focusing on insurance coverage, use of other types of preventive services, length of US residence, limited English proficiency, and health literacy measures.
Specific Aim 3: Exploratory: Using findings from Aims 1-2, targeted literature review, and with guidance from the community advisory board, we will identify relevant, ethnic-specific community interventions and communication strategies, including key health messages about CRC screening, tailored to South Asian American target audiences, accounting for differing preferences for type of screening test, primary care versus specialty care access, health literacy levels, and differing language, gender, and cultural needs. We will also assess the feasibility of the interventions and strategies identified, in preparation for next steps of designing tailored interventions, strategies, and messages to better engage South Asian patients in the uptake of colorectal screening modalities.
Research Project

Community Mobilization to Improve the HIV/AIDS Continuum of Care Among Black Men

HIV rates are at catastrophic levels Among young Black Men who have sex with Men (YBMSM). A study in 21 US cities found that 21% of YBMSM aged 18-29 were HIV+, compared to 9% of Latino and 7% of white young MSM (YMSM), and these disparities are worsening. YBMSM are more likely to be HIV-infected, less likely to be aware of their HIV-infection, and less likely to disclose that they are HIV-infected, relative to Men of other ethnic/racial groups. HIV+ YBMSM are also less likely than white MSM to be in treatment for HIV and to have undetectable viral loads (VLs). When HIV+ individuals achieve an undetectable VL, their own health improves, and they are also less infectious to others. Getting to that point, however, requires that HIV+ individuals: (1) know their HIV status; (2) link to HIV Care; (3) stay in Care over time; (4) begin appropriate treatment; and (5) adhere to antiretroviral therapy (ART). We refer to these steps as engagement in the HIV Care Continuum (CC). While these approaches have great potential to reduce HIV incidence, it is estimated that only 25% of HIV+ people in the US have engaged in the CC to the point of having undetectable VLs. Research suggests that HIV+ YBMSM engage in the CC far less than others. A community-level intervention (CLI) to build and mobilize communities of YBMSM to support HIV+ Men to engage in the CC, decrease psychosocial barriers and increase psychosocial facilitators to engage in the CC within those communities may be an efficacious approach to prevent HIV transmission and Improve health outcomes for YBMSM. This proposal will test the efficacy of such a CLI model, called United Black Element+ (UBE+). UBE+ will be an adaptation of a current CLI, called UBE. UBE has already engaged hundreds of YBMSM in Dallas TX, and it diffuses support for HIV Prevention and creates positive social norms around reducing rates of unprotected sex and increasing regular HIV testing by building an empowered, mobilized YBMSM Community. UBE+ will be an adaptation and extension of UBE designed to increase YBMSM's engagement in the CC. the aims of this project are: (1) to adapt and expand UBE into UBE+, a multilevel intervention that includes a new focus on increasing engagement in the CC Among HIV+YBMSM, including targeting psychosocial barriers and facilitators to engaging in the CC that are experienced in this Community (e.g., HIV stigma and social support); (2) to implement UBE+ in Dallas for 3 years in collaboration with a local AIDS Service Organization currently implementing UBE, the Dallas County Health Department, and the Texas Department of State Health Services' (TDSHS) HIV-STD Program; and (3) to evaluate the efficacy of UBE+ in increasing engagement in the CC in Dallas (utilizing Houston as a control Community) using 2 independent methods: (a) a longitudinal cohort of HIV+ YBMSM providing data on engagement in Care, and experiences of psychosocial and logistic barriers and facilitators to engagement in Care; and (b) public health data that the TDSHS independently collects on HIV+ YBMSM's engagement in the CC.
Research Project

CRUSH: Connecting Resources for Urban Sexual Health

The East Bay AIDS Center (EBAC) and the UCSF Center for AIDS Prevention Studies (CAPS) will work together to fight the HIV epidemic in California by meeting the need for high quality health care for young MSM of color in the eastern San Francisco Bay Area. The CRUSH (Connecting Resources for Urban Sexual Health) project will improve access to state-of-the art health care by combining cutting-edge research at CAPS and compassionate and welcoming services at EBAC.

Research Project

Development and Validation of a Multidimensional Index of Engagement in HIV Care

Less than half of individuals living with HIV in the United States are receiving ongoing Care, and only one- quarter have an undetectable Viral Load. The National HIV/AIDS Strategy prioritizes Care and treatment of HIV- infected individuals, yet improvement in Care retention rates is clearly needed. Research on HIV Care has used attendance at primary Care appointments to assess whether Patients are in Care. While Medical visits are necessary, they are not sufficient and do not necessarily reflect a patient's level of Engagement. Engagement in Care is about the patient experience and interactions with providers and the Care site. We propose to create a patient-centered Index of Engagement in HIV Care that will be framed within a model of Health Care Empowerment, which refers to participation in Care in a way that is engaged, informed, collaborative, committed, and tolerant of uncertainty. We will create the Index through a collaborative process of consensus- building with Patients, providers, and Research experts using iterative online Delphi Surveys and in-person focus groups. We will then translate these narrative findings into scale items and develop them further through cognitive interviewing with Patients. We will validate the Index by administering i to a sample of Patients undergoing the Patient Reported Outcomes within the CFAR Network of Integrated Clinical Systems (CNICS) and examining retrospective, cross-sectional, and prospective Appointment and Viral Load Data. The resulting Index of Engagement in HIV Care will have implications for both Clinical Care and Research, identifying Patients who are at risk fo poor Clinical outcomes and providing a metric by which to develop and evaluate interventions aiming to improve Engagement in Care.